BillsFanM.D.

That, or a bad case of short term amnesia.

sorry. didn't mean to offend.....and sorry to you and Kelly if I got the story wrong. Wasn't sure how to 'label' you....I guess I shouldn't have. Kelly is correct about the meds he mentioned. They are all prescription only. There are other options, however, for mild flares. Many types are available OTC. Check with your new doc! Here we can agree. The 'blood test' for gout is basically useless if used as a screening tool. Your serum 'uric acid' level is the test in question. I have many patients with very low uric acid (prior to any med such as allopurinol) and severe gout. On the flip side...I have folks with relatively high uric acid levels and they've never had a clinical flare of gout. Higher levels do tend to correlate with increased likelihood but it is NOT confirmatory of anything. In short, the test is supposed to be used as a baseline. I.e. a patient is diagnosed with gout based on clinical exam, story and, perhaps, joint aspiration of crystals. If these flares are recurrent, the doc should get a baseline for the uric acid level. It can then be 'followed' to monitor response to a med like allopurinol. I.e. the patients baseline level should decrease with med. Gout should not be 'ruled in' or 'ruled out' based on a blood test alone. Good point Kelly.....

Nonsense? There's lots of evidence with dietary correlation and gout flares. If you have no effect....great! But...don't blindly dismiss it for others. I could give you lots of 'success' stories as well as dietary failures. If you can avoid a 'periodic' flare of gout simply by modifying your diet that is a much better solution than taking a medicine every day the rest of your life. Not to mention, this 'patient' has had one flare of gout.....rather that he reported as 'gout.' Lots of folks have one or two episodes in their entire lifetime. I probably wouldn't recommend much based on one episode other than to look for obvious flares (recent binge drinking, or high protein consumption). Even then, I wouldn't recommend much based on one flare. Prophylactic meds such as allopurinol and colchicine are not indicated at all for one flare. As you point out there are potentially very serious reactions with any med (allopurinol is associated with a potentially life threatening, albeit very rare reaction). It's not worth putting a patient with an isolated flare of gout on this type of daily med(s) for a multitude of reasons. And... both colchicine and allopurinol are not indicated for 'everyone.' If repeated flares occur, then the diet changes should be tried and then prophylaxis should be considered. It's a free country and lots of folks don't like docs. No sweat. As I said earlier, I'm not gonna give advice other than generic information. There are benefits to weight loss and diet if this becomes a recurrent problem. Call your doc and just ask the nurse in the office if there is something you could use for a mild flare. You can also find this on the internet for sure. There are many OTC options that 'might' help your problem. Check with your doc as your underlying (if they exist) med conditions may affect your ability to take them. Good luck!

well I couldn't actually say yes....could I? Keep feeding these guys beef tenderloin with a nice glaze Chef.....it's good for business.

Come on Nanker....nothing wrong with a little "Tim" at the event. Now I'd much rather see the toad than that freaky clown.....

I agree with the first bolded part. Clinton is political gold for the most part. If I was running Obama's campaign, I'd have Clinton everywhere (critical) that I could prop him up. Which leads to second bolded part....It doesn't necessarily mean they are 'terrified' but, as above, Clinton is gold politically. Where he is heading....at this point in the election...has to be strategic at the least, and likely reactive in my opinion.

Romney Romney No

Interesting you bring up PA OC. I live there and for months I've heard zero adds for either candidate on radio. In last two days I've probably heard 20 Romney adds. Obviously...his camp feels like the money is worth spending at this point....and they must feel like a win is within reach. Personally, I'd be surprised but not shocked.

I can't speak to your numbers on the penalty cost..... but I have three very good friends who are hospital administrators. Two in PA and one in FL. I've spoken to all of them and they scoff/laugh at the thought of continuing to pay for employee premiums. Hospitals have razor thin margins....the government is handing them (at the expense of our national debt) a monstrous windfall......along with every other employer with any insight. Doctor flight is a real consideration as well. I'm very concerned about all of this.

Enough already....I win.

He/she/it should buy American next time.....serves 'it' right ....picking up that junk from the Andromeda Galaxy.

I'm not gonna start giving out med advice (I'm sure I could get in trouble somewhere) on a message board but I will say this...... NOOOOOOOOOOOOOO! YEEEEEEEEEEEEESSSS!

ridiculous. As the saying goes...."it's all fun and games...." What would these morons think if they killed a kid via OD/cardiac arrhythmia?

If they acted in good faith the administration should just come out and say it. If they 'did the right things' then there is nothing to hide. You can still investigate for areas of improvement while stating a simple fact. I'm tired of 'we need to do a more thorough investigation.' I'm still trying to maintain benefit of the doubt but this story stinks more every day....and changes way too often. It was a movie....we never said it was a movie....this wasn't terrorism....I've always said it was terrorism....and on and on. Ironically, this could have been Obama's shining moment. Even if a counter attack became like Carter's failed hostage rescue....he could have still looked every American in the eye and said "I don't leave Americans behind." He'd probably have a double digit lead right now if he had.

Nothing wrong with this....not fact as of current day but certainly not a proclamation or guarantee on Ben's part. "adds...hope...one day....maybe" Class of '83....hands down. But Ben's comment is not a ridiculous statement.

Romney 285-253. He gets FL,NC, VA, OH, CO and IA. http://www.270towin.com/2012_election_predictions.php?mapid=bcpt

Does the result truly reflect the 'will and belief' of the country? Better yet....does the 'collective' vote even know what they are voting for? There are very wide ranging beliefs presented on this board (and lots of other places obviously). Most people here seem to have a general knowledge of events/issues and can typically support what they believe and why. It doesn't mean there is a consensus but folks generally present some basis for their 'belief.' I feel, however, that many people voting today have only superficial comprehension of the issues, or none at all. Their reasons for voting for a candidate are ingrained reflexes and more of a 'sports' team approach. We're the best....rah rah rah. "Bush is an idiot"...."Obama is an idiot." Those type of answers are often the reason given for voting for another candidate...rather than an explanation of what that individual voter believes. Think of the Howard Stern interviews with the "Obama supporters." He gives them all of the Republican information and, well, .....you know the rest. That's just an example and there are certainly equally misinformed/ignorant folks on the right. I'm not trying to claim to be some political elitist. There are many folks on this board that know more about politics than I ever will. But, I have a set of beliefs that guide my voting and I can defend them or at least explain them as it pertains to specific issues. In my lifetime.....it appears that there is a rapidly growing population on both sides of the aisle that don't seem to understand... or care to find out. One of my favorite quotes of all time....Winston Churchill: "The best argument against democracy is a five-minute conversation with the average voter."

Happy Birthday! Death, taxes and Mead promoting wine consumption...... The 'definitives' of life! Enjoy!

Nice analysis on the 'whole' issue. I bolded the above sentence as the crux of the matter. In all the 'polling' threads/comments in the last few months.... the issue always seems to boil down to this. Is the bold statement correct or incorrect? I agree with your take but we'll see. Regardless, there is no question that some of the polling has been bizarre.

So....a four month old child thrown in the back yard....separated from it's mother and with no chance of surviving based on its mother's rejection ......is a parasite?

I hear you... and I've seen it here and in discussion with my 'lib' friends. I'm trying to remain non "knee-jerk" in my response but the evidence is certainly mounting. Again....if proven accurate....Obama should have zero support on this issue.

Very disturbing. IF, and I still am saying IF, this is all remotely proven true....NOBODY can defend this guy.

Nate Silver....Nate Silver. Let 'er rip!